Persuasive Technology for the Future of Smoking Cessation*

This paper explores the integration of persuasive technology into smoking cessation efforts through the development and evaluation of a mobile app, “No-Smoke.” Leveraging compelling features like social support, tracking, planning, and motivation, the app aims to augment user engagement and support the process of quitting smoking. The efficacy of these features has been substantiated through both automated testing and user feedback, highlighting their potential to enhance awareness, motivation, and behavior modification. Despite notable successes, limitations, including a limited user base and uncertainties regarding long-term efficacy, have been acknowledged, stemming from the inherent complexities of smoking cessation. Nevertheless, based on user experiences and feedback, “No-Smoke” represents a promising advancement in the use of technology for public health interventions, particularly in the realm of smoking cessation. To address existing challenges, future research is recommended to encompass a comprehensive, long-term study involving a larger and more diverse user base. Additionally, further investigation should focus on personalization enhancements and the integration of machine learning algorithms to better understand and respond to user behavior.

Supporting smoking cessation in healthcare: obstacles in scientific understanding and tobacco addiction management

Despite ongoing efforts to reduce tobacco smoking, the smoking prevalence in many countries has remained stable for years. This may be a consequence of either lack of knowledge about effective ways to reduce smoking, or failing treatment of tobacco addiction in healthcare. This study explored gaps in the current understanding of smoking cessation and the challenges facing tobacco addiction management in order to formulate recommendations for future research and healthcare practice. A narrative review was written to determine areas in which more research is needed as well as areas in which sufficient knowledge is already available. Recommendations for future research were prioritised using a Delphi-procedure. Recommendations for healthcare practice were confirmed by expert’s assessment. Smoking is not widely acknowledged as an addiction and a relatively small number of smokers ask help from a healthcare professional when trying to stop smoking. Most healthcare professionals recognise the importance of advising patients to stop smoking, but experience certain barriers to actually do this. Overall, healthcare professionals need to be convinced that tobacco smoking is an addiction and should be treated likewise. If all healthcare professionals systematically advise their patients to give up smoking, eventually more smokers will successfully stop smoking.

Impacts of Preoperative Smoking and Smoking Cessation Time on Preoperative Peripheral Blood Inflammatory Indexes and Postoperative Hospitalization Outcome in Male Patients with Lung Cancer and Surgery Treatment

Objectives To investigate the effects of preoperative smoking and smoking cessation time on preoperative peripheral blood inflammatory indexes and postoperative hospitalization outcomes in male patients with lung cancer and surgery therapy.Methods We retrospectively enrolled 637 male patients who underwent curative-intent lung cancer resection between January 2014 and December 2016.Patients were classified as the current smokers,the never smokers,and the ex-smokers based on their smoking history,and the ex-smokers were allocated into five subgroups according to their smoking cessation times(CeT):CeT W6 weeks,6weeks<CeT W lyear,lyear<CeT<5years,5years<CeT<lOyears,CeT>10years.The preoperative peripheral blood white blood cells(WBCs),albumin,neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),intraoperative blood loss,30-day mortality,in-hospital days,hospitalization costs,intensive care un辻(ICU),admission days and placement time of closed thoracic drainage tube were compared among difTerent groups.Results There were significant differences in WBC(F=S.275,P<0.001)and albumin(F=2,470,P<0.05)among patients of current smokers,ex-smokers with different smoking cessation time,and never-smokers.The blood WBC count in current smokers(7.7 X 109/L)was significantly higher than that in ex・smokers(7.0 X 109/L)and never-smokers(5.9 X 109/L)(t=-2.145,P<0.05;t=-6.073,P<0.01,respectively).The level of peripheral blood albumin in current smokers(41.1 g/L)was lower than that in ex・smokers(42.1 g/L)and neve—smokers(43.2 g/L)(t=2.323,P<0.05;t=3.995,P<0.01,respectively).The level of peripheral blood NLR in current smokers(3.7)was higher than that in ex-smokers(3.1)and never smokers(2.8)(t—-1.836,P<0.05;t=-2.889,P<0.01,respectively).There was no significant difference in WBC,albumin and NLR among five subgroups of different smoking cessation time.No significant difference was observed in intraoperative blood loss,30-day mortality,hospitalization costs,hospital stay,ICU stay and placement time of closed thoracic drainage tube among groups either.Conclusion Smoking increases the preoperative inflammatory indexes in peripheral blood of lung cancer patients.Smoking cessation has beneficial effect on reducing levels of these inflammatory indexes,which may be not impacted by the time length of smoking cessation.Therefore,lung cancer patients should be encouraged to quit smoking at any time.

Identifying Distinct Quitting Trajectories after an Unassisted Smoking Cessation Attempt: An Ecological Momentary Assessment Study

Objectives: This study aimed at identifying distinct quitting trajectories over 29 days after an unassisted smoking ces- sation attempt by ecological momentary assessment (EMA). In order to validate these trajectories we tested if they predict smoking frequency up to six months later. Methods: EMA via mobile phones was used to collect real time data on smoking (yes/no) after an unassisted quit attempt over 29 days. Smoking frequency one, three and six months after the quit attempt was assessed with online questionnaires. Latent class growth modeling was used to analyze the data of 230 self-quitters. Results: Four different quitting trajectories emerged: quitter (43.9%), late quitter (11.3%), returner (17%) and persistent smoker (27.8%). The quitting trajectories predicted smoking frequency one, three and six months after the quit attempt (all p < 0.001). Conclusions: Outcome after a smoking cessation attempt is better described by four distinct trajectories instead of a binary variable for abstinence or relapse. In line with the relapse model by Marlatt and Gordon, late quitter may have learned how to cope with lapses during one month after the quitting attempt. This group would have been allocated to the relapse group in traditional outcome studies.

Impact of smoking cessation counseling among acute myocardial infarction patients on post-hospitalization mortality rates:a systematic review

Objective:The current systematic review aimed to assess the impact of smoking cessation counseling(SCC)on patients’short-and long-term mor tality after acute myocardial infarction(AMI).Methods:The Cochrane guidelines were used to conduct a systematic review of Medline(Pub Med),Science Direct,CINAHL Cochrane database,and Google Scholar for studies on the impact of SCC on AMI patients’mor tality.Results:Five studies were found to meet the predefined inclusion criteria.Smoker patients were not routinely counseled to quit smoking during their post-AMI hospital stay.Studies showed a reduction in mor tality among AMI patients’who received SCC compared with patients who did not receive it.Conclusions:SCC during hospitalization and after discharge is a simple and cost-effective intervention that improves AMI patients’survival.

Smoking Cessation in the Middle East after Percutaneous Coronary Intervention. Results from the First Jordanian Percutaneous Coronary Intervention Registry (JoPCR1)

Background: Cigarette smoking (CS) is a major risk factor for cardiovascular disease (CVD) in the Middle East. Little is known about the rate of SC in patients following percutaneous coronary intervention (PCI) and the clinical and angiographic features and one-year outcome among quitters compared with persistent smokers. Methods and Results: Of 2425 patients enrolled in a prospective multicenter PCI registry, 1055 (43.5%) were smokers (mean age 53.7 + 5.7 years) and 94% were males. PCI was indicated for ACS in 862 patients (82%). The rate of CS was 33%, 30% and 31%, at 1, 6 and 12 months after discharge, respectively. Compared with persistent smokers, quitters were more likely to have diabetes (50.4% vs. 42.0%;p = 0.028), low left ventricular ejection fraction (18.1% vs. 9.3%;p = 0.0004), and heart failure (15.4% vs. 9.0%;p = 0.0008). There were no differences between quitters and persistent smokers in age, gender, or severity of coronary lesions. Assessing the major complications and cardiovascular events during the index admission and at one year in non-smokers, quitters and persistent smokers showed that the incidence rates of in-hospital major bleeding events and cardiovascular deaths differed significantly among the three groups of patients (p-value = 0.017 for major bleeding, and 0.012 for cardiovascular death). The rates of these two complications were significantly higher among non-smokers compared to quitters and persistent smokers, and the rate of major bleeding was almost double in quitters compared to persistent smokers. Moreover, the three groups differed significantly in the rates of major bleeding, cardiovascular death and coronary revascularization after one year of follow-up. The incidence rates of major bleeding and cardiovascular death after one year were the highest among non-smokers followed by quitters and persistent smokers. The rate of coronary revascularization was significantly higher in quitters compared to non-smokers and persistent smokers. Conclusion: The rate of CS among Middle Eastern patients who undergo PCI is around 30%. Comprehensive secondary prevention strategy in such patients should include an effective smoking cessation program that extends beyond hospital discharge. Larger studies that extend the follow-up for several years are needed to document a positive impact of SC on improving cardiovascular outcome.

Smoking reduction did not promote future smoking cessation in a general population

Introduction: Smoking reduction (SR) has been introduced as a strategy for smokers who are unwilling or unable to quit. We wanted to investi tigate whether SR at one-year follow-up increased the probability of abstinence from smoking at three and five-year follow-up. Methods: we included a random sample from a general population, the Inter99 study, Copenhagen, Denmark. A total of 1975 participants were daily smokers (from both the intervention and the control group) with information on tobacco consumption at both baseline and one-year follow-up (year 1999 to 2001). Of these, 112 had reduced their tobacco consumption substantially, by minimum 50%, at one-year follow-up. Information on tobacco consumption and smoking status was available on 1441 and 1308 participants at three-year and five-year follow-up, respectively. Outcome was self-reported point abstinence at three and five-year follow-up. Logistic regression analyses were adjusted for confounders. Results: One out of five smokers (20.5%) had maintained their reduced tobacco consumption at five-year follow-up. About twice as many reducers as non-reducers reported that they had tried to quit since baseline (p < 0.05). In adjusted logistic regression analyses we found no association between SR at one-year follow- up and being point abstinent at three-year (OR: 0.57;CI: 0.28 - 1.15) or five-year follow-up (OR: 1.08;CI: 0.56 - 2.09). Conclusions: Our study, including smokers from a general population found no association between substantial SR and future smoking cessation at three- and five-year follow-up. No studies so far have reported that SR undermines smoking cessation, but it is still controversial whether SR significantly increases future smoking cessation.

Efficacy of digital therapeutics in smoking cessation: A systematic review and meta-analysis

Intervention based on“digital therapeutics”(DTs)to aid smoking cessation(SC)has developed in recent years.This systematic review and meta-analysis aimed to explore the efficacy of DTs in SC.Databases(PubMed,Embase,Scopus,Institute of Electrical and Electronics Engineers Xplore,ClinicalTrials,Science Direct,Web of Science,China National Knowledge Infrastructure,Chinese Science and Technology Periodical Database,Wanfang,Cochrane Central Register of Controlled Trials)from inception to June 27,2022 were searched to collect randomized controlled trials focusing on use of DTs for SC.Revman 5.3 and Stata16 were used for meta-analysis.After literature screening,data extraction,and quality assessment by two researchers.33 studies(19,749 participants)were included.Compared with the control group,DTs significantly increased the prevalence of abstinence of smokers[OR=1.77,95%CI[1.39,2.26],p=0],significantly increased the point prevalence abstinence(PPA)[OR=1.45,95%CI[1.18,1.78],p=0],and improved participation in SC programs[OR=1.12,95%CI[1.01,1.24],p=0.038].Subgroup analysis showed that,among different intervention groups,the prevalence of DTs-assisted SC in chronic obstructive pulmonary disease(COPD)smokers was higher than that in other groups[OR=5.18,95%CI[1.49,18.05],p=0.001],the prevalence of WeChat-assisted SC in smokers was higher than that in other groups[OR=4.37,95%CI[2.21,8.67],p=0].This meta-analysis showed that DTs-assisted SC improved the prevalence of abstinence,PPA,and increased the participation of smokers in SC programs.

Effect of acupuncture treatment on smoking cessation in smokers from Hong Kong

OBJECTIVE: To analyze the characteristics of smokers treated with acupuncture for smoking cessation in Hong Kong.METHODS: A total of 2051 subjects were recruited in a clinical pilot research project "acupuncture for smoking cessation", which was conducted jointly by Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences and Hong Kong Pok Oi Hospital from January of 2011 to December of 2013. The characteristics of study subjects, including baseline information, smoking background, intention to quit and influencing factors were analyzed.RESULTS: The majority of subjects treated with acupuncture for smoking cessation in Hong Kong was male(66.7%), but the proportion of female smokers in this study(33.3%) was higher than that of female smokers in Hong Kong population(13.8%, P <0.05). Subjects were at the mean age of 43.83 years old, of which the percentage of females aged 31-40 years was the highest(38.8%, P < 0.05). The mean duration of smoking was 25.49 years. The number of cigarettes smoked per day was 17.57 cigarettes.Fagerstrom Test for Nicotine Dependence(FTND)was 5.29 points. Most of the subjects had attempted quitting smoking(81.42%). The confidence index(7.44 points) and the readiness to quit smoking(8.13 points) were high. Subjects quitting smoking were mostly due to health cause(81.91%). The majority of subjects were at the level of middle school(61.63%). The higher the educational level was, the lower the tobacco dependence was and the higher the confidence in successfully quitting smoking was. 50.27% of subjects chose acupuncture for smoking cessation mainly through friends, television and network publicity. Subjects who had received acupuncture had the highest confidence index, while those who wanted to try a new method had the lower confidence index.CONCLUSION: Acupuncture for smoking cessation was more popular in female smokers, especially those aged 31-40 years. The effectiveness of acupuncture-smoking cessation was most significant in the smokers over 60.

Effectiveness of an employment-based smoking cessation assistance program in China

Objective:The objective of this study was to adapt an evidence-based smoking cessation intervention initially developed in the United States to the Chinese context and evaluate the ef-fectiveness of this intervention in China.Method:A smoking cessation program from United States was adapted and implemented through an Employee Assistance Program(EAP)in China.The intervention consisted of recom-mending medication and psychological counseling.Local EAP counselors received training on the program and delivered the intervention to clients.Program evaluation examined the intervention's effectiveness in helping clients quit or reduce the amount of smoking and nicotine dependence.Results:Ninety-day follow-up showed that those who had completed the program were more likely to remain abstinent,or stop smoking daily and have lower levels of nicotine dependence(p<0.05)than those who had dropped out.Conclusions:The evidence-based cessation program is effective in helping Chinese smok-ers quit or reduce the amount of smoking.Moreover,implementing such programs in an EAP setting is a practical approach to providing a wider spectrum of smokers with access to cessation assistance in China.

Assessing the accuracy of patient report of the 5As (ask,assess,advise,assist,and arrange) for smoking cessation counseling

Objective:The 5As framework(ask,advise,assess,assist,arrange)is a recommended strat-egy for smoking cessation counseling in primary care.This study compares patient report with direct observation to assess the degree of recall bias for each of the 5As.Methods:Primary care visits by 107 adult smokers and 16 physicians were audio-recorded.Within 48 hours after the visit,patients completed a survey assessing whether or not smoking was discussed and items specific to each of the 5As.The audio recordings were evaluated to assess the presence of each A.The sensitivity,specificity,positive predictive value,and negative predictive value of patient report versus direct observation were computed.Results:The frequency of the 5As based on evaluation of the audio recording ranged from 13% (arrange)to 98% (ask).The sensitivity and specificity of patient report were 92% and not applicable for ask,90% and 50% for assess,94% and 33% for advise,90% and 50% for assist,and 85% and 67% for arrange follow-up.Positive predictive values ranged from 28% to 98%;negative predictive values ranged from 0% to 97% .Conclusion:Compared with the gold standard of direct observation,patient report of each of the 5As is reasonably sensitive but not specific.Patients overreport the occurrence of each of the 5As.

Impact of Smoking Status on Lipoprotein Subfractions： Data from an Untreated Chinese Cohort

Objective Cigarette smoking is one of the established risk factors of atherosclerotic cardiovascular disease,however,its impact on lipids is not completely understood,especially in the Chinese population.Therefore,this study evaluated the impact of smoking status(non,former,and current smoking) on the distribution of lipoprotein subfractions in untreated patients with angina-like chest pain.Methods A total of 877 patients were consecutively enrolled and divided into nonsmoking(n = 518),former smoking(n = 103),and current smoking(n = 256) groups.Both low-and high-density lipoprotein cholesterol(LDL-C and HDL-C) subfractions were measured using the Quantimetrix Lipoprint System.The distributions of lipoprotein subfractions were evaluated among the groups.Results Compared with nonsmoking subjects,the current smoking group had significantly lower large/medium HDL-C(both P < 0.001) concentration and large HDL subfraction percentage but higher small HDL-C and medium LDL-C concentrations as well as medium LDL subfraction percentage.Importantly,former smoking subjects showed elevated levels of large HDL-C concentration,large HDL particle percentage,and mean LDL particle size and attenuation in small HDL/LDL percentages and small LDL-C concentration,but these levels did not reach the optimal status compared with those of the non-smoking group(data not shown).Conclusion Smoking has an adverse impact on the lipoprotein subfractions,presented as lower large HDL particles besides higher small HDL and medium LDL particles,whereas smoking cessation could reverse these change to a certain degree.

Impact of stopping smoking on metabolic parameters in diabetes mellitus:A scoping review

The purpose of this scoping review is to create a single narrative that describes the impact of smoking cessation on metabolic parameters in people with diabetes.It is generally well accepted that smoking enhances the harmful effects of elevated blood glucose levels,accelerating the vascular damage seen in patients with diabetes.Smoking cessation has clear benefits in terms of reducing cardiovascular morbidity and mortality.However,there is less evidence for the impact of smoking cessation on other diabetes-related complications.Studies in people with diabetes have shown improvement as well as temporary deterioration in glycemic control after ceasing smoking.Only a few studies have described the effect of quitting smoking on insulin resistance and lipid parameters,however,their results have been inconclusive.In this situation,healthcare professionals should not assume that cessation of smoking will improve metabolic parameters in patients with diabetes.It seems they should, first of all, emphasize the prevention of weight gain that may be associatedwith quitting smoking. The lack of data regarding the metabolic effects of smoking and smokingcessation in diabetes is very disappointing and this area needs to be addressed.

Dental Implant Patients Grouped by the Brinkman Index: Their Attitude toward Smoking, Nicotine Dependence, and Knowledge of Peri-Implantitis

Purpose: This study investigated the attitude of patients, grouped by the Brinkman index, towards smoking by using the Kano Test for Social Nicotine Dependence (KTSND) and their knowledge of peri-implantitis. Methods: The participants were 3093 new patients who visited the Tokyo Medical and Dental University Hospital from January 2012 to December 2013 for an oral implant. The methodology included a questionnaire about sex, age, smoking status, daily average number of cigarettes, years of smoking, knowledge of peri-implantitis, and the KTSND. The patients were grouped according to their smoking status by calculating their Brinkman index (over 200 or not): current smokers with the possibility of nicotine dependence (BI(+)CS), current smokers with no possibility of nicotine dependence (BI(-)CS), ex-smokers (ES), and non-smokers (NS). The Brinkman index is obtained by multiplying one’s daily average number of cigarettes by the number of years they have been smoking. Results: Data were collected from 2182 respondents (response rate = 71%). The KTSND scores of BI(+)CS (16.89 ± 4.26) were significantly higher than the scores of ES (11.99 ± 4.52) and NS (11.53 ± 5.01). In current smokers, there were no significant differences between BI(+)CS and BI(-)CS. The patients replied “I don’t know” about peri-implantitis most often in all groups;however, there were no significant differences between the groups. Discussion: BI(+)CS were more dependent on nicotine in social situations than the other groups were. In Japan, a Brinkman index over 200 is required for a nicotine-dependence management fee to be instituted for health insurance treatment. This is a major concern for young smokers, who may be excluded from treatment because their years of smoking are substantially less. Results revealed that there were no significant differences between BI(+)CS and BI(-)CS. Therefore, it was suggested that the Brinkman index did not sufficiently group the participants.

When smoke meets gut:deciphering the interactions between tobacco smoking and gut microbiota in disease development

Tobacco smoking is a prevalent and detrimental habit practiced worldwide,increasing the risk of various diseases,including chronic obstructive pulmonary disease(COPD),cardiovascular disease,liver disease,and cancer.Although previous research has explored the detrimental health effects of tobacco smoking,recent studies suggest that gut microbiota dysbiosis may play a critical role in these outcomes.Numerous tobacco smoke components,such as nicotine,are found in the gastrointestinal tract and interact with gut microbiota,leading to lasting impacts on host health and diseases.This review delves into the ways tobacco smoking and its various constituents influence gut microbiota composition and functionality.We also summarize recent advancements in understanding how tobacco smoking-induced gut microbiota dysbiosis affects host health.Furthermore,this review introduces a novel perspective on how changes in gut microbiota following smoking cessation may contribute to withdrawal syndrome and the degree of health improvements in smokers.

Inhaled nicotine replacement therapy

There are a large number of smokers who want to quit smoking but have failed in their attempts to do so,with many having been unsuccessful at quitting multiple times over their lifetime.The existing marketed nicotine replacement therapies(NRT)have only marginal effectiveness and none provide a comparable physiological response to that derived from cigarette smoking;that is,rapid absorption of nicotine from the lung leading to peak levels of nicotine in the bloodstream to target the receptors in the brain.Instead,existing NRTs produce a slower and delayed rise in nicotine blood levels which is less effective at reducing the craving sensations.Published data for electronic cigarettes show that they typically deliver nicotine with a profile closer to that for nicotine patches,with a slow rise that can take 30–60 min,or longer,to reach the same peak nicotine concentration that is produced in less than 3 min from a single cigarette.A number of attempts have been made to develop an inhaled product which would deliver the nicotine through the lung and mimic the physiological response from smoking,but many of them produced intolerable aversive reactions or delivered an ineffective dose.This paper discusses examples of the potential for the recent inhaled nicotine products in development to be effective as NRTs,but is not meant to be a comprehensive review.

E-Cigarette Survey among Student Pharmacists Reveals Troubling Results

The rise in “vaping”-associated deaths in the United States raises serious concerns. A justification for some level of risk is that e-cigarettes might provide a “reverse-gateway” from smoking traditional cigarettes to a less-harmful alternative. But are users actually smokers? We developed an electronic on-line survey to gather data regarding e-cigarette usage in a target study population of pharmacy students. The survey was created using Google Forms to collect the responses anonymously. We surveyed medical-savvy healthcare students about their e-cigarette use, and whether or not their healthcare providers were aware of their e-cigarette use. Although nearly one-fourth of a convenience sampling of 134 pharmacy-student respondents (23.9%) reported using e-cigarettes, only 2.0% reported prior regular cigarette use, 28% used cartridges containing nicotine and only 11.2% had tried and wanted to quit. The majority (64.1%) reported that their healthcare providers did not ask about such use, and respondents did not volunteer this information. The results of this pilot survey reveal a significant e-cigarette use among health-aware pharmacy students, and they do not support the notion that the respondents do so to quit smoking. The observation that most of the students’ healthcare providers did not inquire about their e-cigarette use, coupled with the finding that users did not volunteer their vaping behavior, suggests that the information should be included when getting a medical history. Further research is needed to determine what behavioral factors may play a role in this type of decision-making among student healthcare professionals.

A revolutionary approach for the cessation of smoking

It is well known that smoking is harmful to our health. It is estimated that 1.3 billion people are smokers worldwide and 5.4 million deaths are caused by tobacco smoking each year. In China, about 1.2 million people die because of smoking

The Effect of the Interaction between Price and Time Preference on Cigarette Consumption among Pregnant Women

In this study,I explore smoking behavior among pregnant U.S.women using the 1979 cohort of the National Longitudinal Survey of Youth.The key aspect of this study is the availability of smoking participation data before and during pregnancy.I consider the probabilities of smoking cessation while pregnant as the outcome.I find that pregnant women who smoke are less responsive to price changes when they are more future-oriented.Women who are more present-oriented are more likely to smoke and consume more cigarettes given that they smoke more than those who are future-oriented.Moreover,those who discount the future more heavily are more sensitive to the money price of cigarettes than those who are more future-oriented.I focus on the role of time preference and the interaction between time preference and price in determining these outcomes.